Achalasia Research Articles

Diagnostic Utility of High-resolution Esophageal Manometry and Its Correlation with Symptoms.

Primary esophageal motility disorders present with a spectrum of symptoms where manometry plays an important role. We designed this study to evaluate the utility of esophageal manometry among various symptoms. This is a single-center observational study conducted over 5 years in a tertiary referral center. A total of 564 patients who underwent high-resolution esophageal manometry (HREM) using a 16-channel water perfusion system were included in the study. Their clinical profile and manometric findings, as per the Chicago classification version 4.0, were recorded, and the diagnostic utility of HREM with respect to symptoms was studied. Motility disorders were identified in 48.8% of patients, the most common being Achalasia cardia (32.4%). Dysphagia (55.5%) was the most common indication of manometry, followed by gastroesophageal reflux disease (GERD) (34.9%), chest pain (6.2%), and symptoms such as belching, globus, and hiccoughs (3.4%). Among those who were re-classified from Chicago classification v3.0 to v4.0, 21.2% had a newer diagnosis. Among the patients with dysphagia, HREM revealed the highest yield of detecting an abnormal esophageal motility test (70.6%); meanwhile, this yield was much lower in those with GERD (21.8%), chest pain (22.8%), and other symptoms (15.7%). The most common finding among those with dysphagia was Achalasia cardia (55.9%), while the study was normal among those with GERD (78.1%), chest pain (77.1%), and other symptoms (84.2%). The sensitivity and specificity of dysphagia for major motility disorders were 65% and 91%, respectively, with a positive predictive value of 90%. HREM has high accuracy and a good diagnostic yield among patients with dysphagia, with the most common finding being Achalasia cardia.

Toll-Like Receptor 7-Expressed Macrophages Are Involved in the Pathogenesis of Esophageal Achalasia and Esophagogastric Junction Outflow Obstruction.

Esophageal achalasia is a typical esophageal motility disorder (EMD). Although viral infections have been hypothesized to play a role in the pathogenesis of esophageal achalasia, its etiology remains unclear. This study used esophageal muscle layer specimens collected during per-oral endoscopic myotomy (POEM) procedures to investigate the association between esophageal achalasia and esophagogastric junction outflow obstruction (EGJOO) and pattern recognition receptors. Patients with esophageal achalasia and EGJOO who underwent POEM were allocated to the EMD group. Biopsies of the inner circular muscle were conducted during the POEM procedure. The control group comprised individuals diagnosed with esophageal squamous cell carcinoma who underwent surgical resection. Expression of pattern recognition receptors, including Toll-like receptor (TLR) 7, was examined by polymerase chain reaction. Immunohistochemical staining was performed to determine TLR7 expression sites in the esophageal muscle layer, and the relationship between TLR7 mRNA expression and clinical score was investigated. Our analysis revealed a notable upregulation of TLR7 mRNA levels within the muscle layer of esophageal achalasia and EGJOO, in contrast to those of control specimens. In contrast, the correlation between TLR7 and clinical score was not significant. Immunohistochemical staining revealed increased numbers of TLR7-expressing macrophages between the muscle layers. TLR7-expressing macrophages are involved in the innate immune response underlying esophageal achalasia and EGJOO. This result will lead to the elucidation of new pathogenetic mechanisms and the development of novel therapeutic targets.

Esophagoplasty Using a Jejunum Segment on a Vascular Pedicle

Aim: to substantiate the expediency of using a segment of the jejunum on a vascular pedicle in esophagoplasty. Materials and methods. At the National Medical Research Center of Surgery named after A.V. Vishnevsky, 12 patients underwent esophagoplasty with a combined visceral transplant, of which 9 (75.0 %) received a gastrointestinal graft and 3 (25.0 %) — a colon-jejunum one. Esophagectomy with simultaneous esophageal plastic surgery was performed in 10 (83.3 %) patients, in 4 (40 %) of them — in combination with distal gastric resection. The indication for surgery in 3 patients was cicatricial stricture of the esophagus and stenosis of the pylorus, in 2 — achalasia of the cardia of the terminal stage (in one patient — with ulcerative stenosis of the pylorus). Three more patients underwent esophagectomy due to peptic strictures: esophagogastroanastomosis (n = 1), esophagoenteroanastomosis (n = 1) and esophagus after Nissen surgery (n = 1). Cancer recurrence after proximal gastric resection and gastrectomy in 2 patients was an indication for esophagectomy. Also, 2 (16.7 %) patients were hospitalized in the National Medical Research Center of Surgery named after A.V. Vishnevsky with incomplete esophagoplasty: one person — after Dobromyslov — Torek surgery for spontaneous rupture of the esophagus, and one patient — after the unsuccessful Lewis surgery for esophageal cancer performed in other hospitals. Results. The average duration of post-operative stay was 12.7 ± 6.3 days. The postoperative period was smooth in 10 (83.3 %) patients. The failure of the cervical anastomosis was revealed in 1 (8.3 %) patient on day 5 after esophageal plastic surgery with colon-jejunum graft, which was resolved conservatively without repeated surgery. Relaparotomy was required in one patient on day 7 after surgery for bile peritonitis, the cause of which was destructive acalculous cholecystitis with perforation. All 12 patients were discharged from the clinic with full nutrition through the mouth. In the long-term period, 11 (91.7 %) patients remained under observation, 1 (9.1 %) developed an esophagogastroanastomosis stricture 1.5 months after esophageal plastic surgery, which was resolved by 4 courses of bougation during the first 9 months after surgery. No other complications were noted. Conclusion. The segment of the jejunum on the vascular pedicle, used for esophagoplasty, in the condition of a shortage of plastic material, allows not only to complete the reconstruction at once, but also to restore the natural passage of food and prevent bile reflux.

Perioperative management protocol for pediatric endoluminal functional lumen imaging probe in esophageal motility disorders.

Lower esophageal sphincter achalasia is associated with a higher risk of aspiration during anesthesia. Endoluminal Functional Lumen Imaging Probe (EndoFLIP) is used as an adjunctive tool in both the diagnosis and treatment of achalasia, for which all children require anesthesia. Anesthesia may affect the parameters of the EndoFLIP due to its effect on gut motility. There are no standard anesthesia protocols to help decrease the risk of aspiration and the undesirable effect of anesthesia on EndoFLIP parameters. This study aims to standardize an anesthesia protocol to target both goals. A protocol was developed to address perioperative management in patients undergoing EndoFLIP for any indication to minimize both anesthetic effect on the esophageal motility as well as perioperative complications. A retrospective data analysis was conducted on patients who underwent EndoFLIP at Cincinnati Children's Hospital Medical Center; pre- and post-protocol implementation data including adverse events was compared. Pre-protocol implementation: 60 cases (median age of 13.8 years, 30 [50%] females) with 2 cases of adverse events (3.3%). Post-protocol implementation: 71 cases (median age of 14.6 years, 37 [52.1%] females) with no adverse events (0/71 = 0%). In comparison between pre- and post-protocol cases, no significant difference was noted in gender, age, and adverse events. Post-protocol procedures were found to be significantly shorter (median time of 89 vs. 79 min, p = 0.004). Our anesthesia protocol provides a standardized way of administering anesthesia minimizing impact on EndoFLIP parameters and aspiration for patients with achalasia.

Laparoscopic Heller’s cardiomyotomy as the main method for treatment of achalasia cardia: an evaluation of treatment results

Achalasia is an esophageal motility disorder characterized by symptoms of dysphagia, regurgitation of undigested food, respiratory symptoms (nocturnal cough, recurrent aspiration, and pneumonia), chest pain, and weight loss. The aim: to evaluate the results of surgical treatment for achalasia cardia by the method of laparoscopic Heller’s cardiomyotomy in combination with Dor fundoplication. Materials and methods. To evaluate the treatment results of achalasia cardia by the method of laparoscopic Heller’s cardiomyotomy with Dor fundoplication, we analyzed 30 case histories of patients who were treated in the period from 2011 to 2022. Inclusion criteria were age 18 years or older, diagnosis of stage II, III cardia achalasia confirmed using instrumental examinations. Exclusion criterion was stage I achalasia. The mean age of the patients was 53.0 ± 15.3 years. In terms of sex, this group was almost equal, there were 14 (46.7 %) women and 16 (53.3 %) men. The average duration of the disease was 5.0 ± 1.2 years. To determine the degree of achalasia, we used the radiological classification of the distal esophageal morphology in achalasia and distinguished 4 stages. Based on this classification, stage II achalasia was detected in 24 (80.0 %) patients, and stage III – in 6 (20.0 %), p = 0.0007, U = 180.0. Results. All the patients were operated on as planned. The total duration of preoperative preparation in the hospital was 0.8 ± 0.2 days. The main method of treatment in this group was laparoscopic Heller’s cardiomyotomy with Dor fundoplication. Conclusions. Laparoscopic Heller’s cardiomyotomy with fundoplication is currently one of the most effective methods of treatment for achalasia cardia. Minimally invasive surgical treatment methods for achalasia are effective in most patients, however, recurrence of symptoms in the long term occurs in 10.0–20.0 %, leaving open the question of finding new effective methods for the treatment of this pathology.

Per oral endoscopic myotomy in esophageal achalasia in children. First endoscopic procedures

BACKGROUND: Achalasia is an esophagus lesion which is characterized by disorders of its motility. It is met extremely rare in childhood. Among the existing techniques of achalasia management, Heller's laparoscopic myotomy is a procedure of choice. Peroral endoscopic myotomy (POEM) is an endoscopic method for AP treating proposed by P. Pasricha in 2007. AIM: To describe the experience of per oral endoscopic myotomy in children. METHODS: The authors performed a retrospective analysis of data taken from the patients with confirmed esophageal achalasia who had had POEM. Clinical efficacy was assessed using the Eckard scale. RESULTS: In 2018–2021, 8 children with average age 14.4 years were treated with POEM surgery. Before POEM, 2 children underwent balloon dilatation of the cardia. The surgery was technically performed in all children. Dysphagia was eliminated in all patients, and none of them required any additional intervention. A significant decrease in Eckard scale scores was registered in all children after surgery. CONCLUSION: Our results confirm findings that POEM is an effective procedure for treating esophageal achalasia. However, a longer follow-up period and a larger group of patients are needed to confirm POEM role in the management of children with esophageal achalasia.

Esophageal Achalasia in Parkinson’s Disease: Diagnosis and Management of a Rare Case

Esophageal Achalasia in Parkinson’s Disease: Diagnosis and Management of a Rare Case

Esophageal viral and bacterial microbiome unbalances characterize achalasia

Achalasia is a rare neuromuscular disorder of the esophagus whose pathogenesis is poorly understood. It is characterized by the loss of nerve cells in the esophagus, failure of the lower esophageal sphincter to relax, and impaired esophageal peristalsis. In this study, we re-analyzed transcriptomics data from blood and esophageal tissue samples of achalasia patients publicly available. Blood analysis showed hyperactivation of the immune system and dysfunction of the nervous system, consistent with the hypothesis of immune-mediated pathogenesis leading to neuronal loss. Mucosal tissue analysis e showed a remarkable unbalance in virome and bacteriome compositions in achalasia. In particular, bacterial diversity was reduced across the esophagus in achalasia compared to healthy controls, and in the distal esophagus bacteria associated with the healthy state, such as Firmicutes, Tenericutes, and Bacteroidetes, were less represented if not completely absent. Importantly, the only other component of the microbiota that varied significantly between achalasia and controls was the virome. Bacteriophages that parasite Firmicutes were strongly enriched in the esophagus supporting a predator-prey interaction. In conclusion, our study opens new horizons on a circulating signature of achalasia and the role of viral-bacterial interactions in orchestrating mucosal homeostasis and possibly disease pathogenesis. Key summaryAchalasia is a rare swallowing disorder with unknown causes. The role of gut microbiota, especially viruses, in achalasia is unclear. This study investigated the differences in viral and bacterial communities between achalasia patients and healthy people, and how they affect the esophageal mucosa. The findings may help develop new diagnostic tools and therapies based on novel hypotheses about the pathogenesis of achalasia.

Ayurvedic management of Achalasia cardia: Case report

Ayurvedic management of Achalasia cardia: Case report

Endoscopic ultrasonography in the assessment of physiological cardia in esophageal achalasia

Background. Recently, to assess the physiological cardia in esophageal achalasia (EA), the method of endoscopic ultrasonography (EUS) has been used, which combines the capabilities of two studies, endoscopic and ultrasound, in addition to traditional diagnostic methods, radiography and endoscopy, and allows detecting structural changes in the esophageal wall and lower esophageal sphincter (LES). Objective: to determine the role of endoscopic ultrasonography in assessing the state of phy­siological cardia in esophageal achalasia. Materials and methods. In the Department of Digestive Surgery of the SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023–2024, according to the objectives of the study, 15 patients with EA and 20 practically healthy individuals (control group) were examined. All patients underwent X-ray and endoscopic examination of the oesophagus, stomach, duodenum, and EUS. Results. Videoesophagogastroduodenoscopy revealed changes characteristic of EA: dilation of the esophageal diameter (100.0 %), stagnant contents in the esophageal lumen (66.7 %), resistance to the passage of an endoscope through LES (86.7 %). X-ray revealed EA stage I in 13.3 % of cases by peristalsis and esophageal diameter, stage II — in 33.3 %, stage III — in 46.7 %, and stage IV — in 6.7 % of cases. When performing EUS, the esophageal hiatus was 19.29 mm (normal 23–36 mm); the eso­phageal wall thickness in the middle third was 6.76 mm (normal < 3 mm); the LES wall thickness was 6.02 mm (normal < 5 mm). To detect fibrotic changes in the esophageal and the LES wall, compression elastography was used. This method helped reveal a significant thickening of the internal circular muscle of the LES from 2.5 to 4.5 mm in 46.6 % of cases, and in 26.6 %, with EA stage III and IV, fibrotic changes were detected in the lower third of the esophageal wall. Conclusions. It has been found that EUS in EA answers questions that are not answered by traditional research methods, namely, it makes it possible to assess a number of parameters (thickness of the walls of the LES and the lower third of the esophagus, diameter of the esophageal hiatus) and identify structural changes (the presence of fibrosis), which significantly affects the choice of a method for a surgical correction of physiological cardia in EA.

Manometric profile of patients presented with dysphagia – A hospital-based descriptive study

Objectives: The prevalence of dysphagia is 16–22%. Achalasia is characterised by impaired relaxation of the lower oesophageal sphincter (LES) and absent oesophageal peristalsis. Minimally invasive procedures, endoscopic pneumatic balloon dilatation (PD) and peroral endoscopic myotomy (POEM) are treatments of choice. We aimed to assess the manometric profile of patients presented with dysphagia and pre- and post-LES pressure and integrated relaxation pressure (IRP) of patients who underwent PD and POEM. Materials and Methods: One hundred and twenty-nine patients presented with dysphagia underwent high resolution oesophageal manometry (HREM). Manometric parameters: IRP, LES and pattern of motility were noted. According to Chicago classification 4.0, those who are diagnosed with achalasia underwent PD (17) and POEM (15). Statistical analysis was performed using the Statistical Package for the Social Sciences version 28. Pre- and post-procedure values (IRP and basal LES) were compared using the Wilcoxon signed-rank test. Results: Out of 129 patients with dysphagia, 57 had increased IRP and 75 had simultaneous motility. The mean LES pressure and IRP were found to be 28 ± 19.82 and 17 ± 14.04 mmHg, respectively. On analysis, of patients who underwent procedures PD (17) and POEM (15), a statistically significant decrease in IRP was observed in patients with post POEM compared to post PD status (P = 0.005 and 0.017, respectively). Reduced basal LES pressure was observed in patients with post-POEM status compared to post-PD status, which was not statistically significant. Conclusion: About 44% of patients presented with dysphagia were diagnosed with achalasia cardia. POEM procedure was found to be more effective compared to pneumatic dilatation.

Two onset types of achalasia and the long-term course to diagnosis.

Recently, the incidence of achalasia has been increasing, but its cause remains unknown. This study aimed to examine the initial symptoms and the course of symptoms and to find new insights into the cause and course of the disease. Altogether, 136 patients diagnosed with achalasia by high-resolution manometry (HRM) were enrolled. Questionnaires and chart reviews were conducted to investigate the initial symptoms, time from onset to diagnosis, and comorbidities, as well as the relationship between HRM results, time to diagnosis, and symptom severity. In total, 67 of 136 patients responded to the questionnaire. The median ages of onset and diagnosis were 42 and 58years, respectively. The median time from onset to diagnosis was 78.6months, with 25 cases (37.3%) taking > 10years to be diagnosed. The symptom onset was gradual and sudden in 52 (77.6%) and 11 (16.4%) patients, respectively. Of the 11 patients with acute onset, three (27.3%) developed anhidrosis at the same time. There was no correlation between the time from onset to diagnosis and esophageal dilatation, resting LES pressure, or mean integrated relaxation pressure (IRP). No correlation was also found between the degree of symptoms and resting LES pressure or IRP. Esophageal achalasia can have acute or insidious onsets. This finding may help to elucidate the cause of achalasia.

Case Report and Therapeutic Approach for Achalasia Cardia

Achalasia cardia is an uncommon esophageal motility disorder characterized by the impaired relaxation of the lower esophageal sphincter (LES) and the absence of peristaltic contractions in the esophageal body. This report presents a case of a 42-year-old woman with a prolonged history of dysphagia and regurgitation of solids and liquids. The patient's clinical history included a 10-year history of neck swelling, hypothyroidism, and diabetes mellitus. Physical examination and laboratory investigations revealed normal findings, except for elevated blood glucose, thyroid hormone levels, and thyroid-stimulating hormone (TSH) levels. An esophagogram showed proximal dilation of the distal esophagus with a contrast fluid level, and endoscopy revealed a tight LES, which was difficult to pass through. Based on these findings, the diagnosis of achalasia cardia was established. Initial medical management with nitrates and proton pump inhibitors did not provide significant improvement. Subsequently, the patient underwent laparoscopic Heller's myotomy with fundoplication, which successfully resolved her dysphagia symptoms. This case report highlights the diagnostic challenges and the importance of a multidisciplinary approach in managing achalasia cardia. It emphasizes the role of surgical interventions, such as Heller's myotomy with fundoplication, in alleviating symptoms and restoring esophageal function when conservative medical management fails

The evolution of the treatment of esophageal achalasia. Chronicle of a 35-year journey

Over the last few decades, significant improvement has been made in both the evaluation and treatment of esophageal achalasia. The Chicago classification, today in version 4.0, is now the standard for diagnosis of achalasia, providing a classification into 3 subtypes with important therapeutic and prognostic implications. Therapy, which was at first mostly limited to pneumatic dilatation, today includes minimally invasive surgery and peroral endoscopic myotomy, allowing for a more tailored approach to patients and better treatment of recurrent symptoms. This review chronicles my personal experience with achalasia over the last 35 years, describing the progress made in the treatment of patients with achalasia.

A case of terminal stage of esophageal achalasia combined with Barrett' esophagus

A case of terminal stage of esophageal achalasia combined with Barrett' esophagus

Docking Proteins Upregulate IL-1β Expression in Lower Esophageal Sphincter Muscle in Esophageal Achalasia.

Background/Objectives: Esophageal achalasia is an archetypal esophageal motility disorder characterized by abnormal peristalsis of the esophageal body and impaired lower esophageal sphincter (LES) relaxation. Methods: In this study, the mRNA expression of docking proteins 1 and 2 (DOK1 and DOK2, respectively) were analyzed and the mechanisms underlying achalasia onset were investigated. Results:DOK1 and DOK2 mRNA levels significantly increased in the LES of patients with achalasia. Moreover, significant correlations were observed between IL-1β and DOK1, IL-1β and DOK2, ATG16L1 and DOK1, and HSV1-miR-H1-3p and DOK2 expression levels. However, a correlation between ATG16L1 and DOK2 or between HSV-miR-H1-3p and DOK1 expression was not observed. In addition, a positive correlation was observed between patient age and DOK1 expression. Microarray analysis revealed a significant decrease in the expression of hsa-miR-377-3p and miR-376a-3p in the LES muscle of patients with achalasia. Conclusions: These miRNAs possessed sequences targeting DOK. The upregulation of DOK1 and DOK2 expression induces IL-1β expression in the LES of achalasia patients, which may contribute to the development of esophageal motility disorder.

Complications after Heller myotomy in children: a national multicenter study on the impact of prior endoscopic dilatation and identification of risk factors.

Although esophageal achalasia has been historically treated by Heller myotomy, endoscopic esophageal dilatations are nowadays often the first-line treatment in children. The aim was to assess whether performing an endoscopic dilatation before a Heller myotomy is associated with higher risks of esophageal perforation in children. A retrospective multicentric study was performed, including children that underwent a Heller myotomy (2000-2022, 10 centers). Two groups were compared based on the history of previous dilatation before myotomy. Outcomes esophageal perforation (intra-operative or secondary) and post-operative complications requiring surgery (Clavien-Dindo III). Statistics Comparisons using contingency tables or Kruskal-Wallis when appropriate. Statistical significance: p-value < 0.05. A Heller myotomy was performed in 77 children (median age: 11.8 years), with prior endoscopic dilatation in 53% (n = 41). A laparoscopic approach was used in 90%, with associated fundoplication in 95%. Esophageal perforation occurred in 19% of children (n = 15), including 12 patients with intra-operative mucosal tear and 3 with post-operative complications related to an unnoticed esophageal perforation. Previous endoscopic dilatation did not increase the risk of esophageal perforation (22% vs 17%, OR: 1.4, 95%CI: 0.43-4.69). Post-operative complications occurred in 8% (n = 6), with similar rates regardless of prior endoscopic dilatation. Intra-operative mucosal tear was the only risk factor for post-operative complications, increasing the risk of complications from 5 to 25% (OR: 6.89, 95%CI: 1.38-31.87). Prior endoscopic dilatations did not increase the risk of esophageal perforation or postoperative complications of Heller myotomy in this cohort of children with achalasia. Mucosal tear was identified as a risk factor for post-operative complications.

Radiomics analysis of the tissue content of the esophageal hiatus of normal subjects without esophageal symptoms (establishing control values)

Introduction: The opening in the diaphragm through which the esophagus enters from the thorax into the abdomen, i.e., esophageal hiatus is formed by the right crus of the diaphragm. During esophageal peristalsis, the lower end of the esophagus, i.e., lower esophageal sphincter (LES), slides from the abdomen into chest, which we suspect is due to the presence of fat in the hiatus that serves as a lubricant. A recent study from our laboratory found that in patients with achalasia esophagus, the LES and crus of diaphragm are firmly anchored together, which we suspect is due to the loss of fat from the hiatus. Gray scale intensity analysis of the radiological images can be used to determine the nature of tissue, i.e., fat, connective tissue, muscle etc. Goal: To establish gray scale values of the esophageal hiatus from the CT scan images in controls. Methods: 42 patients who had undergone an abdominal CT scan for symptoms unrelated to upper gastrointestinal pathology were selected for this analysis. These patients had no esophageal symptoms and were not taking any medications related to the esophagus and stomach, which included acid inhibition medications. The CT scan was visualized in the Visage (San Diego, CA), a software program that allows rotation of images in X, Y and Z planes to visualize the esophageal hiatus in a 2D image. A software (Segcrus) was built to perform the grayscale intensity analysis of the 3 regions of equal size in the image, 1) subcutaneous fat, 2) muscle, and 3) esophageal hiatus. The 3 regions of interest were demarcated manually in the 2D image. The inner margin of the hiatus was selected as the region of interest for the hiatus image. The software generated a statistical non-parametric method approximation using kernel density estimation (KDE) of the grey scale intensity distributions of the 3 regions of interest. The median values were computed to represent the central tendencies of the distributions, providing an insight into the typical greyscale values of the tissue types. Results: distinct patterns in the region intensity distributions for hiatal region, muscle, and fat were seen. For the hiatus, the values were (Median = 105), interquartile range (IQR = 80.3), and range (Min = 61.5, Max = 137.95), providing a comprehensive description of central tendency, variability, and data spread. For muscle, (Median = 139.92), interquartile range (IQR = 71.1), and range (Min = 119.67, Max = 157.17), and for fat, (Median = 48.24), interquartile range (IQR = 52.9), and range (Min = 23.99, Max = 67.79. Hiatus to fat tissue intensity overlap was not related to BMI (r=0.17, p=0.29), or Age (r=-0.04, p=0.82). There was a notable correlation between the overlap of Hiatal-Muscle tissue intensity and Age (r=0.38, p=0.012). However, such correlation was not observed with BMI (r=-0.3, p=0.06). Additionally, there was no significant correlation between the overlap of Hiatal-Fat tissue intensity and gender (r=-0.26, p=0.09), and similarly, the overlap of Hiatal-Muscle intensity showed no correlation with sex (r=0.09, p=0.58). The results highlight the variability and central tendencies within these tissue types across the normal subjects. Conclusion: These analysis in subjects with no esophageal symptoms may be used as control values to determine if there are difference in the tissue content of the esophageal hiatus between normal and patients with various esophageal motility disorders. R01 DK109376. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cardiovascular Autonomic Deficits in Different Types of Achalasia.

Background and objective Achalasia cardia is a primary esophageal motility disorder, and the etiopathology of this disease's progression is not known. Moreover, autonomic dysfunction has not been studied in different types of achalasia. In light of this, we aimed to address this lack of data in this study. Methods The diagnosis of achalasia was done using high-resolution esophageal manometry (HRM)-based Chicago classification v4.0. Autonomic function tests (AFT) such as the head-up tilt test, deep breathing test (DBT), Valsalva maneuver (VM), handgrip test (HGT), and cold pressor test (CPT),as well as the heart rate variability (HRV) test, were performed among the cohort and the results were compared with those of 39 age- and sex-matched healthy controls. Results AFT and HRV tests were done on 62 patients (30 achalasia type I, 28 type II, and 4 type III) and compared with 39 age- and sex-matched healthy controls. The mean duration of symptoms, high Eckardt score, and dysphagia were most common in type I achalasia, followed by type II and III. The results of AFT showed a generalized loss of parasympathetic and baroreflex-independent sympathetic reactivity in all types of achalasia. However, baroreflex-dependent cardiovascular adrenergic reactivity was normal. Regarding cardiac autonomic tone, there was a loss of parasympathetic and sympathetic influence, but sympathovagal balance was maintained. The severity of the loss of autonomic functions was higher in type I, followed by type II. Conclusions In all types of achalasia, parasympathetic reactivity, baroreflex-independent sympathetic reactivity, and cardiac autonomic tone were lower compared to healthy controls, and the severity of dysfunction increased during the progression of the disease from type II to type I.

Prevention of inadvertent injury of diaphragm during posterior peroral endoscopic myotomy for achalasia cardia

Prevention of inadvertent injury of diaphragm during posterior peroral endoscopic myotomy for achalasia cardia